Efficacy and safety of lamivudine treatment for chronic hepatitis B in pregnancy

Su, Guan-guan; Pan, Kong-Han; Zhao, Nan; Fang, Su-hua; Yang, De Ren; Yong, Zhou

doi:10.3748/wjg.v10.i6.910

Cited by 80 publications

(61 citation statements)

References 17 publications

(25 reference statements)

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“…However, lamuvidine use has been extensively reported in HIV infected women during pregnancy and shown to be well tolerated and safe. 70 Thus, to conclude, pregnancy with portal hypertension may be associated with adverse maternal and perinatal outcome especially in cirrhotic portal hypertension but pregnancy is not contra-indicated as was once believed. Better outcomes can be expected in the modern era with better diagnostic and treatment modalities.…”

Section: Drugs Used In Liver Diseasementioning

confidence: 94%

Pregnancy with Portal Hypertension

Aggarwal

Negi

Aggarwal

et al. 2014

Journal of Clinical and Experimental Hepatology

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Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of noncirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. ( J CLIN EXP HEPATOL 2014;4:163-171) P regnancy associated with liver diseases is an infrequent situation, but when seen together, presents a complicated clinical situation. Portal hypertension develops as a result of number of etiologies. In the west, cirrhosis is the commonest cause of portal hypertension. In the setting of cirrhotic portal hypertension, pregnancy is very rare due to hepatocellular damage leading to amenorrhea and infertility, the incidence of cirrhosis in pregnancy has been reported as 1 in 5950 pregnancies. 1 Cirrhosis may get exacerbated during pregnancy and has significant adverse effects on the mother and the baby. [2][3][4] In the developing countries, other causes like extrahepatic portal vein obstruction contribute significantly to noncirrhotic portal hypertension (NCPH). Mostly liver function is much better preserved in women with NCPH and pregnancy is spontaneous in these women. Portal hypertension associated with pregnancy is a high risk situation as both pregnancy and portal hypertension share some of the hemodynamic changes. The physiological changes, in adaptation to the pregnancy and fetal needs, worsen the portal hypertension resulting in potentially life-threatening variceal bleed and other complications. Pregnancy is a potential hazard for occurrence of recurrent variceal bleed due to its hyperdynamic state causing increase in flow to the collaterals. 5-7 Therefore management in pregnancy requires knowledge of both the effects of changes during pregnancy on portal hemodynamics and the effects of portal hypertension and its cause on both mother and fetus, hepatotoxic...

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Section: Drugs Used In Liver Diseasementioning

confidence: 94%

Pregnancy with Portal Hypertension

Aggarwal

Negi

Aggarwal

et al. 2014

Journal of Clinical and Experimental Hepatology

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“…For women who become pregnant while receiving oral NA therapy, current guidelines recommend continuing treatment if the drug is a category B drug such as telbivudine and tenofovir [34]. Emerging evidence suggests that the use of lamivudine in the last month of pregnancy might prevent mother-to-infant transmission of HBV in women with high HBV DNA levels [36][37][38][39][40].…”

Section: Antiviral Treatment Options For Chb In Women Of Childbearingmentioning

confidence: 99%

Chronic hepatitis B in Asian women of childbearing age

Leung

2009

Hepatol Int

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Hepatitis B virus (HBV) infection is a serious clinical problem affecting approximately 2 billion people worldwide. An estimated 350 million live with chronic hepatitis B (CHB) infection and are at an increased risk for serious liver sequelae and death from acute or chronic consequences of CHB infection. Individuals with CHB have a 20-30% risk of early death from complications, including liver cirrhosis and hepatocellular carcinoma. In the Asia-Pacific region, half of the CHB burden results from vertical or mother-to-child transmission, with early childhood horizontal transmission accounting for the remaining half. Screening and vaccination are key factors in the successful prevention and control of HBV infection. Over the last 20 years, the implementation of screening programs and universal HBV vaccination for all individuals born in endemic areas have reduced the prevalence of HBV infection and HBV-related liver diseases among individuals younger than 30 years. Women of childbearing age are key stakeholders in preventing HBV infection and, as such, play a critical role in reducing the vertical and horizontal transmission of HBV. Further efforts are needed to implement screening and educational programs for women of childbearing age, particularly those with CHB, to prevent the transmission of HBV to newborns, spouses, other household members, and sexual partners. In addition, healthcare workers need to learn how to avoid iatrogenic transmission in the healthcare setting. This article reviews these issues and highlights areas in which their engagement with public health efforts serves to improve quality of life and society as a whole.

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“…Lamivudin HBV ile infekte çok sayıda hastada tedavi deneyimi bulunan antiviraldir. Yapılan çalışmalarda lamivudinin perinatal bulaş oranlarını azalttığı ve tedavi almayan gebelere göre komplikasyon ve fetal yan etki oranlarında anlamlı bir artışa neden olmadığı saptanmış, gebelikte etkili ve güvenli bir şekilde kullanılabileceği bild irilmiştir (6,11,16,22,23,32) . Su ve ark.…”

Section: Discussionunclassified

“…Su ve ark. (22) yaptıkları çalışmada kendi isteğiyle gebeliğin başın-dan itibaren lamivudin tedavisine devam eden 38 gebede ve çocuklarında herhangi bir yan etki saptamamıştır. Ayrıca lamivudin ve tenofovir ilk trimesterde en çok tecrübe edilen ve güvenilir olduğu kanıtlanan iki ilaçtır.…”

Section: Discussionunclassified

“…Gebelik döneminde HBV DNA seviyeleri yüksek gebelerde nükleozid analogları (NA) kullanılmasının viral yükü azaltarak etkili olabileceği ve doğumda aşı ve HBIG uygulamasına ek olarak gebeliğin son trimesterinde lamivudin ve telbivudin tedavisinin güven-li olduğu ve intrauterin geçişi azalttığı saptanmıştır (12,13,22,31,34) . Perinatal bulaşın en önemli bulaş yollarından biri olduğu ülkemizde HBsAg taşı-yıcı gebelerin ve çocuklarının takipleriyle ilgili halen genel bir görüş ve yeterli bir çalışma olmadığından çeşitli aksaklıklar yaşanmaktadır.…”

Section: Introductionunclassified

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